超声内镜在后腹腔镜下内生性肾脏肿瘤保留肾单位手术中的初步应用

目的尝试应用超声内镜指导后腹腔镜下内生性肾脏肿瘤保留肾单位手术,总结临床实践经验,探讨其可行性及临床价值。方法对1例28岁女性右肾占位患者(肿瘤大小1.4 cm×1.0 cm,临床分期为T1aN0M0)行后腹腔镜下保留肾单位手术;术中因肾脏表面光滑,无明显突起,无法准确定位肿瘤,以超声支气管镜探头定位肿瘤,观察肿瘤血供及其与周围肾脏组织的关系;按超声内镜定位标志行保留肾单位手术。观察切除肿瘤的完整性及切缘情况。结果超声内镜下肿瘤范围、血供清晰可辨,阻断肾动脉后未见肿瘤周围有明显血流声像,沿肿瘤边缘约0.5～1.0 cm完整切除肿瘤,术中未中转开放手术。超声内镜操作时间为5 min。术后病理提示血管平滑肌脂肪瘤,切缘阴性。结论在1例后腹腔镜下内生性肾脏肿瘤保留肾单位手术中应用超声内镜成功进行了肿瘤定位、肿瘤血供评判,为彻底切除肿瘤提供了依据,值得进一步研究以利于临床推广。

Ultrasonic endoscopy in retroperitoneal laparoscopic nephron-sparing surgery for endogenous renal tumor: an initial experience

ObjectiveTo assess the feasiblity of using ultrasonic endoscopy in retroperitoneal laparoscopic nephron-sparing surgery for treatment of endogenous renal tumor, and to summarize our clinical experience.MethodsA female patient, aged 28 years old, was found to have a mass (diameter 1.4 cm×1.0 cm, clinical stage T1aN0M0) in the right upper part of the kidney. Retroperitoneal laparoscopic nephron-sparing surgery was performed. The tumor could not be accurately located during the operation due to the smooth renal surface; then ultrasonic endoscopy was used to locate the tumor; and color Doppler mode was used to observe the blood supply of the tumor and its relation with surrounding tissues. The nephron-sparing surgery was performed following the guidance of ultrasonic endoscopy positioning; the integrity of tumor resection and surgical margin were also observed.ResultsThe involvement of the tumor and its blood supply were clearly displayed by ultrasonic endoscopy. No noticeable signals of blood flow were seen around the tumor after blocking the renal artery, and the tumor was totally and thoughly removed with a negative margin of 0.5-1.0 cm. There was no transfer to opening surgery. The procedure of ultrasonic endoscopy lasted for 5 min. Postoperative pathological results indicated angiomyolipoma with negative margins.ConclusionOur initial clinical practice suggests that ultrasonic endoscopy is safe and benificial for retroperitoneal laparoscopic nephron-sparing surgery in treatment of endogenous renal tumors, especially for observing the tumor location, tumor blood supply, and the integrity of resection.